tbuckley/cabot-search huggingface dataset:
Assessing Extracellular Vesicles in Human Biofluids Using Flow‐Based Analyzers
Authors: Kevin Ho Wai Yim, Olga Krzyzaniak, Ala'a Al Hrout, Ben Peacock, Richard Chahwan
Journal: Advanced Healthcare Materials (2023)

Abstract Extracellular vesicles (EVs) are increasingly being analyzed by flow cytometry. Yet their minuscule size and low refractive index cause the scatter intensity of most EVs to fall below the detection limit of most flow cytometers. A new class of devices, known as spectral flow analyzers, are becoming standards in cell phenotyping studies, largely due to their unique capacity to detect a vast panel of markers with higher sensitivity for light scatter detection. Another class of devices, known as nano‐analyzers, provides high‐resolution detection of sub‐micron‐sized particles. Here, the EV phenotyping performance between the Aurora (Cytek) spectral cell analyzer and the NanoFCM (nFCM) nanoflow analyzer are compared. These two devices are specifically chosen given their lead in becoming gold standards in their respective fields. Immune cell‐derived EVs remain poorly characterized despite their clinical potential. Therefore, B‐ and T‐cell line‐derived EVs and donor‐matched human biofluid‐derived EVs from plasma, urine, and saliva are used in combination with a panel of established immune markers for this comparative study. A comparative evaluation of both cytometry platforms is performed, discussing their potential and suitability for different applications. It is found that nFCM can accurately i) analyze small EVs (40−200 nm) matching the size accuracy of electron microscopy; ii) measure the concentration of a single EV particle per volume; iii) identify underrepresented EV marker subsets; and iv) provide co‐localization of EV surface markers. It can also be shown that human sample biofluids have unique EV marker signatures that can have future clinical relevance. Finally, nFCM and Aurora have their unique strength, preferred fashion of data acquisition, and visualization to fit different research interests.
Risk of Recurrence After Radiation in Early Prostate Cancer—Role of Risk Stratification From Prospective Trials
Authors: Martin W. Schoen, Charles L. Bennett
Journal: JAMA Network Open (2023)

Mutlay Sayan, MD; Jiaming Huang, MS; Wanling Xie, MS; Ming-Hui Chen, PhD; Marian Loffredo, RN, OCN; Elizabeth McMahon, RN; Peter Orio, DO; Paul Nguyen, MD; Anthony V. D’Amico, MD, PhD
Pre-emptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): a prospective randomized controlled trial
Authors: Niti Shrestha, Bo Han, Chunmei Zhao, Wenqing Jia, Fang Luo
Journal: International Journal of Surgery (2023)

Background: Postoperative pain after laminoplasty and laminectomy occurs partially from local trauma of the paraspinal tissue. Finding a multimodal analgesic cocktail to enhance the duration and effect of local infiltration analgesia is crucial. Because of rapid onset and long duration of action of betamethasone, we hypothesized that, a preemptive multimodal infiltration regimen of betamethasone and ropivacaine reduces pain scores and opioid demand, and improves patient satisfaction following laminoplasty and laminectomy. Materials and methods: This prospective, randomized, open-label, blinded endpoint study was conducted between September 1, 2021 and June 3, 2022, and included patients between the ages of 18 to 64 scheduled for elective laminoplasty or laminectomy under general anesthesia, with American Society of Anesthesiologists classification I/II. 116 patients were randomly assigned to either the BR (Betamethasone-Ropivacaine) group or the R (Ropivacaine) group in a 1:1 ratio. Each group received preemptive infiltration of a total of 10 ml study solution into each level. Every 30 ml of study solution composed of 0.5 ml of Betamethasone plus 14.5 ml of saline and 15 ml of 1% ropivacaine for the BR group, and 15 ml of 1% ropivacaine added to 15 ml of saline for the R group. Infiltration of epidural space and intrathecal space were avoided and spinous process, transverse process, facet joints and lamina were injected, along with paravertebral muscles and subcutaneous tissue. Cumulative 48 hours postoperative butorphanol consumption via PCA (Patient-controlled analgesia) was the primary outcome. Intention-to-treat (ITT) principle was used for primary analysis. Results: Baseline characteristics were identical in both groups ( P &gt;0.05). The cumulative 48 hours postoperative butorphanol consumption via PCA was 3.0 1.4 mg in the BR group (n=58), and 7.1 1.2 mg in the R group (n=58) ( P &lt;0.001). Overall cumulative opioid demand was lower at different time intervals in the BR group ( P &lt;0.001), along with the estimated median time of first analgesia demand via PCA (3.3 hours in the BR group and 1.6 hours in the R group). Visual Analogue Scale (VAS) score at movement and rest were also significantly lower until 3 months and 6 weeks, respectively. No side effects or adverse events associated with the intervention were observed in this study. Conclusions: Preemptive analgesia with betamethasone and ropivacaine provides better postoperative pain management following laminoplasty and laminectomy, compared to ropivacaine alone. This is an effective technique worthy of further evaluation.
An engineered nanoplatform cascade to relieve extracellular acidity and enhance resistance-free chemotherapy
Authors: Yuqing Tong, Meng Gu, Xingyu Luo, Haifeng Qi, Wei Jiang, Yu Deng, Lulu Wei, Jun Liu, Yin Ding, Jianfeng Cai, Yong Hu
Journal: Journal of Controlled Release (2023)
Effect of mode of delivery of patient reported outcomes in patients with breast disease: a randomised controlled trial
Authors: Eirini Pantiora, Lia-Chasmine Hedman, Iliana Aristokleous, Olivia Sjökvist, Andreas Karakatsanis, Aglaia Schiza
Journal: International Journal of Surgery (2023)

Background: Patient Reported Outcomes (PROs) have an integral role on how to improve patients’ overall experience. The optimal PROs delivery in patients with breast disease is an important issue since PROs are steadily integrated in routine care. Methods: An institutional phase 3 randomised controlled, open-label trial. Eligible candidates were adult women with perceived or confirmed breast disease. Computer generated randomisation was used to allocate interventions: collection of PROs in electronic or paper form. Our objective was the effectiveness of electronic versus paper form of PROs. The main outcome measures were: response rate, reported experience, administrative resources and carbon dioxide emissions. Results: 238 patients were randomised. After loss-to-follow-up and consent withdrawals, 218 participants (median age, iqr=55, 21; n=110 / n=108) were included in the per-intention-to-treat analysis. Response rate was 61.8% for electronic patient reported outcomes (ePROs) and 63.9% for paper patient reported outcomes (pPROs) (difference=−2.1%, 95% CI: -15.8%, 11.7%). Only known breast cancer at recruitment was predictive for response in multivariable analysis. ePROs were associated with 57% reduction in administrative time required, 95% reduction in incremental costs and 84% reduction in carbon dioxide emissions, all differences being significant. No difference was detected in perception of PRO significance or ease of completion, but participants experienced that they needed less time to complete ePROs [median, (iqr) 10 (9) respectively 15(10)]. Finally, respondents would prefer ePROs over pPROs (difference 48.1%, 95%CI 32.8%, 63.4%). Conclusion: ePROs do not increase response rate in patients with perceived or confirmed breast disease. However, they can enhance patient experience, reduce incremental costs, facilitate administrative logistics and are more sustainable. On the basis of these findings, both modalities should continue to be available.
Risk stratification model integrating nutritional and inflammatory factors for predicting 1-year mortality after valvular heart surgery: a retrospective cohort study
Authors: Jin Sun Cho, Youn Joung Cho, Jae-Kwang Shim, Yunseok Jeon, Seohee Lee, Hee Won Choi, Young-Lan Kwak
Journal: International Journal of Surgery (2023)

Introduction: Existing risk-scoring systems for cardiac surgery include only standard preoperative factors, without considering nutritional and inflammatory status or intraoperative factors. The objective of this study was to develop a comprehensive prediction model for mortality incorporating nutritional, inflammatory, and perioperative factors in patients undergoing valvular heart surgery. Materials and methods: In this retrospective review of 2,046 patients who underwent valvular heart surgery, Cox and LASSO regression analyses were performed to identify independent prognostic factors of 1-year postoperative mortality among various perioperative factors known to affect prognosis, including objective nutritional and inflammatory indices. A novel nomogram model incorporating selected prognostic factors was developed, and its discrimination ability was evaluated using the C-index. The model was validated in internal and external cohorts. Results: The 1-year mortality rate after valvular heart surgery was 5.1% (105 of 2,046 patients) and was significantly associated with several preoperative objective inflammatory and nutritional indices. Cox and LASSO analyses identified the following five independent prognostic factors for mortality: monocyte-to-lymphocyte ratio (an objective inflammatory index), EuroSCORE II, Controlling Nutritional Status score, cardiopulmonary bypass time, and number of erythrocyte units transfused intraoperatively. Our nomogram model incorporating these five factors had a C-index of 0.834 (95% CI 0.791–0.877), which was higher than that of EuroSCORE II alone (0.744, 95% CI 0.697–0.791) ( P &lt;0.001). The nomogram achieved good discrimination ability, with C-indices of 0.836 (95% CI 0.790–0.878) and 0.727 (95% CI 0.651–0.803) in the internal and external validation cohorts, respectively, and showed well-fitted calibration curves. Conclusions: A nomogram model incorporating five inflammatory, nutritional, and perioperative factors, as well as EuroSCORE II, was a better predictor of 1-year mortality after valvular heart surgery than EuroSCORE II alone, with good discrimination and calibration power for predicting mortality in both internal and external validation cohorts.
The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study
Authors: Lukas Schlager, Matthias Monschein, Jessica Schüller, Michael Bergmann, Christoph Krall, Peter Razek, Anton Stift, Lukas W. Unger
Journal: International Journal of Surgery (2023)

Introduction: Surgical- and nonsurgical complications significantly worsen postoperative outcomes, and identification of patients at risk is crucial to improve care. This study investigated whether comorbidities, graded by the Charlson Comorbidity Index (CCI), impact complication rates and impair long-term outcome in a cohort of left-sided colorectal resections. Methods: Retrospective analysis of patients undergoing oncological left-sided colorectal resections due to colorectal cancer between 01/2015 and 12/2020 in two referral centers in Austria using electronic medical records and national statistical bureau survival data. Patients with recurrent disease, peritoneal carcinomatosis, and emergency surgeries were excluded. Comorbidities were assessed using the CCI, and complication severity was defined by the Clavien–Dindo classification (CDC). Logistic regression analysis was performed to identify factors influencing the risk for postoperative complications, and overall survival was assessed using data from the national statistics bureau. Results: A total of 471 patients were analyzed. Multinominal logistic regression analysis identified a CCI greater than or equal to 6 ( P =0.049; OR 1.59, 95% CI: 1.10–2.54) and male sex ( P =0.022; OR 1.47, 95% CI: 1.21–2.98) as independent risk factors for major complications. While patients with a high CCI had the worst postoperative survival rates, perioperative complications only impacted on overall survival in patients with low CCIs, but not in patients with high CCIs. Conclusion: Although a high CCI is a risk factor for major postoperative complications, the presence of comorbidities should not result in withholding surgery.
Peripheral Blasts in a Patient Receiving Chemotherapy
Authors: Sabin Kshattry, Terri L. Parker, Scott F. Huntington
Journal: JAMA (2023)

An older patient with stage II bladder carcinoma presented with 1 week of fatigue and 2 days of dyspnea on exertion. He was receiving carboplatin/gemcitabine with 6 mg of pegylated G-CSF chemotherapy; his white blood cell count was elevated, hemoglobin low, and ferritin notably increased. What is the diagnosis and what would you do next?
PUFAs add fuel to Crohn’s disease-associated AIEC-induced enteritis by exacerbating intestinal epithelial lipid peroxidation
Authors: Weiwei Wen, Yihan Xu, Wenwei Qian, Liangyu Huang, Jianfeng Gong, Yi Li, Weiming Zhu, Zhen Guo
Journal: Gut Microbes (2023)

Polyunsaturated fatty acids (PUFAs) have been shown to exacerbate Crohn's disease (CD) by promoting lipid peroxidation (LPO) of intestinal epithelial cells (IECs). Dysbiosis of the gut microbiota may play a crucial role in this process. CD patients often exhibit an increased abundance of Escherichia coli (E. coli) in the gut, and the colonization of adherent-invasive E. coli (AIEC) is implicated in the initiation of intestinal inflammation in CD. However, the impact of AIEC on LPO remains unclear. In this study, we observed that AIEC colonization in the terminal ileum of CD patients was associated with decreased levels of glutathione peroxidase 4 (GPX4) and ferritin heavy chain (FTH) in the intestinal epithelium, along with elevated levels of 4-Hydroxynonenal (4-HNE). In vitro experiments demonstrated that AIEC infection reduced the levels of GPX4 and FTH, increased LPO, and induced ferroptosis in IECs. Furthermore, arachidonic acid (AA) and docosahexaenoic acid (DHA) supplementation in AIEC-infected IECs significantly aggravated LPO and ferroptosis. However, overexpression of GPX4 rescued AIEC-induced LPO and ferroptosis in IECs. Our results further confirmed that AIEC with AA supplementation, associated with excessive LPO and cell death in IECs, worsened colitis in the DSS mouse model and induced enteritis in the antibiotic cocktail pre-treatment mouse model in vivo. Moreover, treatment with ferrostatin-1, a ferroptosis inhibitor, alleviated AIEC with AA supplementation-induced enteritis in mice, accompanied by reduced LPO and cell death in IECs. Our findings suggest that AIEC, in combination with PUFA supplementation, can induce and exacerbate intestinal inflammation, primarily through increased LPO and ferroptosis in IECs.
Robotic versus open surgery for simultaneous resection of rectal cancer and liver metastases: a randomized controlled trial
Authors: Wenju Chang, Qinghai Ye, Donghao Xu, Yu Liu, Shizhao Zhou, Li Ren, Guodong He, Guofeng Zhou, Fei Liang, Jia Fan, Ye Wei, Xiaoying Wang, Jianmin Xu
Journal: International Journal of Surgery (2023)

This study aimed to compare the short-term and long-term outcomes between robotic-assisted simultaneous resection and open surgery in patients with rectal cancer and liver metastases.Open simultaneous resection of colorectal cancer and synchronous liver metastases is widely performed and the potential cure for eligible patients. However, the feasibility of robotic simultaneous resection of primary and secondary liver lesions has not been established as a treatment option for metastatic rectal cancer.A single-center randomized controlled trial was conducted at a hospital in China. Enrolling patients were aged from 18 to 75 years and diagnosed with surgically resectable metastatic rectal cancer (distal extension to ≤15 cm from the anal margin). Patients selected for simultaneous resection were randomly assigned to have robotic or open surgery at a 1:1 ratio. The primary endpoint was the incidence rate of complications within 30 days after surgery. Secondary endpoints were bladder, sexual function, 3-year disease-free survival, and overall survival.A total of 171 patients were enrolled in this trial with 86 in the robotic group and 85 in the open group. As a result, patients in the robotic group demonstrated fewer complications within 30 days after surgery than those in the open group (31.4 vs. 57.6%, P =0.014) and no mortality seen in either group. Patients in the robotic group had less blood loss [mean (SD), 125.5 (38.3) vs. 211.6 (68.7) ml; P <0.001], faster bowel function recovery [mean (SD), 63.7 (27.4) vs. 93.8 (33.5) h P <0.001] and shorter hospital stay [mean (SD), 8.0 (2.2) vs. 10.7 (5.4) days; P <0.001] compared with those in the open group. The robotic group had a faster recovery of bladder and sexual function at 3 months after surgery than that of the open group. The 3-year disease-free survival rate (39.5 vs. 35.3%, P =0.739) and the 3-year overall survival rate (76.7 vs. 72.9%, P =0.712) were not statistically significant between the two groups.In our randomized clinical trial, robotic simultaneous resection treatment of patients with rectal cancer and liver metastases resulted in fewer surgical complications, and a faster recovery to those of open surgery. Oncological outcomes showed no significant difference between the two groups.
Prediction models of surgical site infection after gastrointestinal surgery: a nationwide prospective cohort study
Authors: Yiyu Yang, Xufei Zhang, Jinpeng Zhang, Jianwei Zhu, Peige Wang, Xuemin Li, Wei Mai, Weidong Jin, Wenjing Liu, Xiuwen Wu, Jianan Ren
Journal: International Journal of Surgery (2023)

Objective: This study aimed to construct and validat a clinical prediction model for Surgical site infection (SSI) risk 30 days after gastrointestinal surgery. Materials and methods: This multi-centre study involving 57 units conducted a 30-day postoperative follow-up of 17,353 patients who underwent gastrointestinal surgery at the unit from 1 March 2021 to 28 February 2022. We collected a series of hospitalisation data, including demographic data, preoperative preparation, intraoperative procedures, and postoperative care. The main outcome variable was SSI, defined according to the Centres for Disease Control and Prevention guidelines. This study used the least absolute shrinkage and selection operator (LASSO) algorithm to screen predictive variables and construct a prediction model. The receiver operating characteristic curve, calibration, and clinical decision curves were used to evaluate the prediction performance of the prediction model. Results: Overall, 17,353 patients were included in this study, and the incidence of SSI was 1.6%. The univariate analysis combined with LASSO analysis showed that 20 variables, namely, chronic liver disease, chronic kidney disease, steroid use, smoking history, C-reactive protein, blood urea nitrogen, creatinine, albumin, blood glucose, bowel preparation, surgical antibiotic prophylaxis, appendix surgery, colon surgery, approach, incision type, colostomy/ileostomy at the start of the surgery, colostomy/ileostomy at the end of the surgery, length of incision, surgical duration, and blood loss were identified as predictors of SSI occurrence ( P &lt;0.05). The area under the curve values of the model in the train and test groups were 0.7778 and 0.7868, respectively. The calibration curve and Hosmer–Lemeshow test results demonstrated that the model-predicted and actual risks were in good agreement, and the model forecast accuracy was high. Conclusions: The risk assessment system constructed in this study has good differentiation, calibration, and clinical benefits and can be used as a reference tool for predicting SSI risk in patients.
Renal Response Outcomes of the <scp>EuroLupus</scp> and National Institutes of Health Cyclophosphamide Dosing Regimens in <scp>Childhood‐Onset</scp> Proliferative Lupus Nephritis
Authors: Christine S. Wang, Rebecca E. Sadun, Wenru Zhou, Kristen R. Miller, Laura Pyle, Stacey P. Ardoin, Christine Bacha, Emily Hause, Joyce Hui‐Yuen, Nicole Ling, Maria Pereira, Meredith Riebschleger, Kelly Rouster‐Stevens, Aliese Sarkissian, Julia Shalen, William Soulsby, Marinka Twilt, Eveline Y. Wu, Laura B. Lewandowski, Scott E. Wenderfer, Jennifer C. Cooper
Journal: Arthritis & Rheumatology (2023)

Objective We compared clinical characteristics and renal response in patients with childhood‐onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen. Methods A retrospective cohort study was conducted at 11 pediatric centers in North America that reported using both CYC regimens. Data were extracted from the electronic medical record at baseline and 3, 6, and 12 months after treatment initiation with CYC. To evaluate the adjusted association between CYC regimen (EuroLupus vs NIH) and renal response over time, generalized estimating equations with a logit link were used. An interaction between time and CYC regimen was included, and a contrast between CYC regimens at 12 months was used to evaluate the primary outcome. Results One hundred forty‐five patients (58 EuroLupus, 87 NIH) were included. EuroLupus patients were on average older at the start of current CYC therapy, had longer disease duration, and more commonly had relapsed or refractory LN compared with the NIH group. After multivariable adjustment, there was no significant association between CYC regimen and achieving complete renal response at 12 months (odds ratio [OR] of response for the EuroLupus regimen, reference NIH regimen: 0.76; 95% confidence interval [CI] 0.29–1.98). There was also no significant association between CYC regimen and achieving at least a partial renal response at 12 months (OR 1.35, 95% CI 0.57–3.19). Conclusion Our study failed to demonstrate a benefit of the NIH regimen over the EuroLupus CYC regimen in childhood‐onset proliferative LN. However, future prospective outcome studies are needed. image
Comparing the safety and efficacy of sleeve gastrectomy versus Roux-en-Y gastric bypass in elderly (&gt;60 years) with severe obesity: an umbrella systematic review and meta-analysis
Authors: Mohammad Kermansaravi, Antonio Vitiello, Rohollah Valizadeh, Shahab Shahabi Shahmir, Mario Musella
Journal: International Journal of Surgery (2023)

Today, bariatric surgeons face the challenge of treating older adults with class III obesity. The indications and outcomes of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) also constitute a controversy.PubMed, Web of Science and Scopus were searched to retrieve systematic reviews/meta-analyses published by 1 March 2022. The selected articles were qualitatively evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR).An umbrella review included six meta-analyses retrieved from the literature. The risk of early-emerging and late-emerging complications decreased by 55% and 41% in the patients underwent SG than in those receiving RYGB, respectively. The chance of the remission of hypertension and obstructive sleep apnoea, respectively increased by 43% and 6%, but type-2 diabetes mellitus decreased by 4% in the patients underwent RYGB than in those receiving SG. RYGB also increased excess weight loss by 15.23% in the patients underwent RYGB than in those receiving SG.Lower levels of mortality and early-emerging and late-emerging complications were observed in the older adults undergoing SG than in those receiving RYGB, which was, however, more efficient in term of weight loss outcomes and recurrence of obesity-related diseases.